Okaloosa County BOCC — 2013 meeting #1139 (date undetermined) — MEDICAID ORIGINAL 2009 — reading text

k. . Consider information presented by or on behalf of a Medicaid Beneficiary relative to the need for Transportation Services upon each such request Jor transportation, notwithstanding preyiousdenials. of .service.. " J. Except as otherwise specified below, require that a Medicaid Beneficiary and associated Attendant/Escort be picked up from, and returned to, a common address. m. Ensure that Medicaid is the payor of last resort and that the Medicaid Beneficiary does not have access to any other form of transportation service to a Medicaid compensable service. 5. If the STP requires an application process to determine eligibility for Transportation Services, the STP shall provide Transportation Services to all Medicaid Beneficiaries requiring Urgent Trips pending the STP's final eligibility determination. C. Trip Limiting Procedure 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 25 of 117  1. Nothing in the Trip Limiting Procedure detailed below supersedes the Commission's or AHCA's prohibition against limiting specific types of Trips as set forth in the Gate Keeping section above. 2. The STP may limit the total number of daily Medicaid Trips available so long as the STP completes the following Trip limitation procedure: a. The STP shall provide all detailed background information explaining why the STP feels it must initiate Trip limits to the Recipient no less than sixty (60) Calendar Days before the STP plans to initiate Trips limits. The background information shall include the following: (1) An explanation as to why the STP needs to initiate Trip limits and what it plans to do to resolve the issues that require the STP to request Trip limits as quickly as possible; (2) The STP's process for establishing a daily budget; (3) The STP's current Gate Keeping strategies/programs and how the STP intends to revise its Gate Keeping strategies/programs to ensure a swift return to normal provision of Transportation Services; (4) The STP's Costs and an explanation of its financial situation; (5) A copy of the notification the STP proposes to mail to all affected Medicaid Beneficiaries at least thirty (30) Calendar Days before it plans to initiate its Trip limits. The STP's letter should state that trips for dialysis, chemotherapy, etc. are exempt from the UPC2rTl in gTriplimits, . (6) The STP's current daily budget allocation and the STP's projected daily budget allocation during the period the STP proposes to limit Trips; and (7) A specific date upon which the STP expects to be able to provide Transportation Services without Trip limits, not to exceed ninety (90) Calendar Days. b. Upon receipt of the Trip Limiting request from the STP, the Commission shall review the information and, within ten (10) Business Days, either: (1) Forward documentation with analysis as to why the request is necessary and reasonable to AHCA for approval. Send written notification to the STP that request has been submitted to the AHCA for approval; 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 26 of 117  (2) Deny the STP's request and send written notification to the STP; or (3) Forward documentation with analysis for partial approval of request to AHCA for approval and notify the STP in writing of such action. (STP may request a trip limit of 30 trips but the Commission recommends a Trip limit of forty (40) Trips per day for AHCA's approval). c. If the STP's Trip limit request submission is incomplete or does not adequately explain the reasons it feels that it must initiate Trip limits, the Commission shall deny the STP's request and send a copy of the denial to the Agency for Health Care Administration. d. Upon receipt of the documents from the Commission, the Agency shall have ten (10) business days to review the information and either: (1) Approve the STP's request and send written notification to the Commission; (2) Disapprove the STP's request in full and send written notification of the Agency's disapproval to the Commission, or (3) Approve the STP'srequest in part and send written notification to the Commission with specific instructions as to which partes) the Agency approves. (a) Example - The STP requests a Trip limit of thirty (30) Medicaid compensable Trips per day, but the Agency for Health Care Administration approves a Trip limit of forty (40)Tripsperi:fay. ... .. . ............ . ... . e. The STP shall acknowledge the Commission's/Agency's final determination within five (5) Business Days. If the Agency grants only partial approval, the STP must specify in its acknowledgement that it will abide by the final approved Trip limit program. f. If the STP wants to extend the Trip limit, the STP must supply the Commission and the Agency at least thirty (30) Calendar Days before the first Trip limit period ends with an explanation as to why the initial Trip limit period was insufficient to meet the goals set forth in the STP's original proposal and how the STP plans to be able to resume normal services at the end of the second ninety (90) day period. The Commission and the Agency may approve an extension of up to ninety (90) days. g. The Agency will not allow a STP to conduct more than two (2) Trip limit periods during a three-hundred sixty-five (365) Calendar Day period. If a STP is unable to provide the full spectrum of Transportation Services 2008/2009 Medicaid NonMEmergency Transportation Subcontracted Transportation Provider Contract Page 27 of 117  without limiting Trips after two (2) Trip limit periods in a 365 Calendar Day period, the Commission shall terminate the STP and procure a new STP. III. MEDICAID BENEFICIARY SERVICES A. Medicaid Beneficiary Services 1. General Provisions a. The STP shall have written policies and procedures for the provision of Transportation Services, as specified in this Agreement b. The STP shall ensure that Medicaid Beneficiaries are aware of their rights and responsibilities, how to obtain Transportation Services, what to do in an Emergency 'or Urgent Care situation, how to file a Complaint, Grievance, Appeal, or Medicaid Fair Hearing, how to report suspected Fraud and Abuse, and all other requirements and Covered Services. c. The STP shall have the capability to answer Medicaid Beneficiary inquiries via written materials, telephone, electronic transmission, and face-to-face communication. d. The STP shall not charge the Commission, Agency for Health care Administration or Medicaid Beneficiaries for printing written materials. e. The STP must make oral interpretation services available free of charge to non-English speaking Medicaid Beneficiaries. This applies to all non- English languages, not just those that the State identifies as prevalent. The STP shall not charge the Commission, Agency for Health Care Administration or the Medicaid BenefiCiary for interpretation services. The STPshall notify all-Medicaid Beneficiaries that oral interpretation is available for any language and written information is available in prevalent languages, and how to access those services. 2. Medicaid Beneficiary Communications a. Requirements for all CommuniC;:ltions (1) The Commission and the AHCA must approve, in writing, all written, website and verbal communications developed by the STP for distribution/transmission to Medicaid Beneficiaries before communication. (2) The STP shall make all written communications available in alternative formats and in a manner that takes into conSideration the Medicaid Beneficiary's special needs, including those who are visually impaired or have limited reading proficiency (e.g., Braille, 2008/2009· Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 28 of 117  large print format, etc.). The STP shall notify all Medicaid Beneficiaries that information is available in alternative formats and how to access those formats. (3) The STP shall make all written communications available in English, Spanish, and all other